A Nordic perspective on female stress urinary incontinence care: Lessons for shared clinical practice.

Stress urinary incontinence (SUI) affects up to 36% of women. It reduces the quality of life and increases the economic burden of individuals and societies. From an international perspective, the populations of each Nordic country are relatively small; however, shared ethnicities and economic approaches allow a collective view of the Nordic population. We have conducted a state-of-the-art review of diagnostic criteria, treatment strategies, follow-up procedures, and economic aspects of female SUI in the Nordic countries to identify and discuss common themes to advocate a combined and harmonized Nordic data pool. A 21-question survey concerning female SUI was created and refined by an expert group comprising experienced and leading urogynecologists from the Nordic countries. Data were gathered from the questionnaire, available national guidelines and Nordic registries, and clinical practices within the five Nordic countries. Additionally, a literature search for SUI from the Nordic countries was conducted. Diagnostic criteria and preoperative evaluation are mostly consistent across the Nordic countries. Differences were noted in the utilization of stress test and uroflowmetry measures. Norway reported the highest prevalence of invasive treatments. In Denmark, Norway, and Sweden, patients undergo a postoperative follow-up, documented in the national registries, while no such follow-up is conducted in Finland and Iceland. The literature review revealed a strong interest in the long-term effects of mid-urethral sling (MUS) operations, comparability of MUS versus injection treatments, the efficacy of conservative treatment strategies, and the overall quality of life associated with SUI pre- and postoperatively. We examined current practices for treating female SUI across the Nordic countries. National guidelines and registries are important tools for monitoring, evaluating, and improving quality and cost efficiency. Differences in the frequency of invasive treatments and the lack of follow-up procedures in Finland and Iceland call for further discussion about developing common Nordic strategies. Increasing costs necessitate efficient preventive and management strategies, and a more harmonized Nordic database would help to achieve these goals. Current Nordic literature lacks studies on costs and cost-effective strategies for SUI, and more research on the subject is needed.